North-west Region Of England Research Articles

Skills required in developing electronic commerce for small and medium enterprises: case based generalization approach

There has been a rapid growth in electronic commerce worldwide. However, the UK government and other governments had noted that electronic commerce uptake among Small and Medium Enterprises (SMEs) has been slow. In this paper we examine the skills and knowledge required for successful electronic commerce projects in the UK SME sector based upon detailed case studies in three SME organisations from the Northwest region of England over a two year period. B2C electronic commerce appears to involve a greater requirement for skills relating to website animation, website promotion, content management, and relevant legislation compared to B2B electronic commerce. Conversely, B2B electronic commerce potentially requires more detailed knowledge of electronic data interchange technologies compared to B2C electronic commerce.

The beliefs of people with chronic pain in relation to ‘important’ treatment components

Background. The beliefs of people with chronic pain (service users) about the importance of treatment components offered through both multidisciplinary and other types of chronic pain programmes are not widely examined in the literature. Aim and method. As part of a wider research study of the congruence between what service providers and service users believe to be important treatments for chronic pain, members of three chronic pain support groups located in the North-West region of England were surveyed. The survey asked service users’ opinion about whether specific treatment components are important or not important for people with chronic pain. The survey also included Skevington’s Beliefs About Pain Control Questionnaire (BPCQ) that measures beliefs in the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events. Results and conclusion. Findings show that no treatment components were endorsed as important by more that 67% of the participants. Endorsements clustered around treatments that focused on self-management and biomedical interventions. A statistically significant relationship emerged between certain treatment components and BPCQ scores. These findings contribute to the growing cautions regarding standardised, ‘one-size-fits all’ treatment programs and the mistake of assuming people with pain form a homogenous group.

Best practice researched: teachers' expectations of the impact of doing research in their classrooms and schools

This article will draw on an investigation of teachers' research in a small-scale project involving 19 schools in the North West region of England. The teachers engaged in the research were funded by a government initiative, the Best Practice Research Scholarships Programme, and were mentored and tutored by university staff. The sample is very small and the teachers elected to participate in the data collection. From analyses of questionnaires and semi-structured interview data emerge teachers' expectations and reports of the impact of doing research in classrooms and schools. Common themes in investigating good classroom practice and professional development can be explored and identified. Issues discussed include the development of teaching strategies, pupil achievement, teacher collaboration and school improvement, mentoring and support roles undertaken by tutorial staff in the university in support of teachers' research. Finally, a number of issues will be discussed which have implications for the current debate about teachers' research and raise questions for the future. The authors' comments relate only to a limited part of the professional development activity of a small group of teachers engaging in classroom-based research, but hopefully they are both illustrative and indicative.

Enhanced surveillance of campylobacter infection in the North West of England 1997-1999.

To identify sources and routes of infection for sporadic cases of campylobacter infection in the North West of England. Standard, structured questionnaires were used to gather epidemiological information from cases of campylobacter infection in the North West Region of England between 1997 and 1999. The strains of campylobacter isolated from these cases were identified and typed using serotyping and phage typing methods. Analysis of combined serotype and epidemiological data is presented. Human campylobacter infection in the North West is seasonal and a new observation was a peak in cases in March each year. Drinking bird-pecked milk was a highly seasonal exposure that might be an indicator of environmental contamination with campylobacter. A possible environmental basis for seasonality of infection is discussed. Frequencies of risk exposures related to serotypes of cases are described and a potential association was demonstrated between Campylobacter jejuni HS6 and consumption of bird-pecked milk. Also, Campylobacter coli infections were more commonly associated with travel abroad than C. jejuni and a decreased proportion of C. jejuni HS2 and C. jejuni HS11 reported consumption of meat and unpasteurised milk (respectively). Contact with a sick animal may be a significant risk exposure in younger age groups and in those who do not consume poultry or meat. It is clear from this and other studies that the sources and vehicles of human campylobacter infection are numerous and interventions that target a single risk factor are unlikely to impact significantly on the overall burden of disease.

Developing Institutional Capacity at the Regional Level: The Development of a Coastal Forum in the North West of England

This paper examines the process of establishing a coastal forum in the North West region of England. The North West Coastal Forum is one of the first attempts at the establishment of a regional forum in England and is especially notable for the role played by the Government Office for the North West in its formation. The paper examines the relationships between the key agencies involved and, in particular, the key role played by the Government Office for the North West in promoting and establishing the forum and how this has influenced its organization, structure and composition. It provides a critical analysis of the apparent and potential strengths and weaknesses of the forum as an example of a partnership approach to the planning and management of coastal issues in the North West. The conclusions are not only of relevance to the future development of the forum within the North West of England, and to the potential establishment of similar coastal fora elsewhere, but are also of much broader interest as a case example of the development of institutional capacities and collaborative partnership approaches to planning issues at the regional level in the wider context of the changing nature of regional governance in the UK and the enhanced 'regional partnership' role being embraced by the government offices for the regions.

Suspected testicular torsion: a survey of clinical practice in North West England

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete). As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation. The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or non-absorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.

Suspected testicular torsion: a survey of clinical practice in North West England.

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete). As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation. The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or non-absorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.

The prescription and relative outcomes of different materials used in general dental practice in the north west region of England to restore the primary dentition

Objective. To identify the type of restorative materials used in general dental practice and their effects on the outcomes of restorative treatment of primary teeth. Method. The study involved a retrospective investigation of case notes of 677 child patients of 50 general dental practitioners (GDPs) in the northwest of England. The history of dental care received by each child during the primary dentition period was recorded. The type of restorative material used and the number of times that each tooth was restored were recorded. The proportion of primary teeth that were extracted due to pain or sepsis was calculated according to whether they were filled by amalgam or glass ionomer, or were left unfilled. Results. Of the treated teeth, 61% of first and 55% of second primary molars were restored with glass ionomer. Some 27.4% of first molars restored with amalgam required repeat restorations, compared with 42.5% of those filled with glass ionomer. The difference was highly significant ( p<0.001). For all primary molar teeth, there was no difference in the proportion of extractions, according to the type of restorative material used or if carious teeth were left unrestored. Conclusions. In the hands of GDPs, glass ionomer restorations are used most commonly and are significantly more likely to require replacement than amalgam restorations. The type of restorative material used had no influence on outcomes.

Using the Delphi technique to identify the cancer education requirements of general practitioners

Introduction Continuing education for the general practitioner (GP) is in need of revision. Much of today’s continuing education is based upon a traditional didactic approach, which is believed to be inappropriate and inefficient for the learning needs of the increasingly stretched GP. Objective To investigate the educational needs of a group of GPs, using the response to cancer to construct an appropriate model for the provision of care in general practice. Method The Delphi technique was adopted to reach ‘expert’ consensus. Participants 49 GPs currently practising within two health authorities within the north-west region of England. Design Three waves of data collection were employed, with the same sample and the inclusion of an additional reference group. Results Many issues relating to the difficulties experienced by GPs regarding care of cancer patients were identified, along with associated training needs. Successive rounds of this Delphi survey enabled consensus to be reached about the level of importance to be assigned to these issues. This technique avoided some of the problems associated with a conventional committee approach (e.g. time, expense and potential bias in decision-making process). Conclusions First, the Delphi technique provided a relatively quick means of gaining a consensus on the complex task set for participants. Second, continuing training for GPs would benefit from the adoption of a problem-based learning approach rather than traditional didactic methods.

Community surveys of self-reported diarrhoea can dramatically overestimate the size of outbreaks of waterborne cryptosporidiosis

This paper describes a community-based study undertaken to assess the size of a waterborne outbreak of cryptosporidiosis in the North West region of England. The outbreak was linked to a single reservoir in the English Lake District and provided drinking water to over 1.2 million people. There were some 308 laboratory confirmed cases. We conducted a community-based survey for self-reported diarrhoea in four towns within the outbreak area and four control towns. The rate of self-reported diarrhoea was higher in the control towns than in the outbreak towns. It would appear that retrospective community-based studies of diarrhoeal disease are subject to recall bias that would overestimate the incidence of illness, especially following reporting in the media. In the light of our findings, we reviewed the study undertaken during the Milwaukee outbreak that produced the estimated size of 405,000 cases. It is suggested that the estimate of the size of the Milwaukee outbreak is severely flawed, and the actual size of this outbreak was between 1% and 10% of that claimed.

Virtual tools for complex problems: an overview of the AtlasNW regional interactive sustainability atlas for planning for sustainable development.

AtlasNW Regional Interactive Sustainability Atlas project allows users to explore the north-west region of England both within the present as a gateway to fostering a greater understanding of developmental issues (Explorer) and also into the future using a scenario model based on the Canadian QUEST software (FutureQUEST). The final prototype model will consist of an urban development, resources, transport and air emissions module together with the necessary economic model framework and will be targeted at two principal audiences: regional policymakers; and the general public through a user-friendly awareness-raising tool. This paper focuses on the development of the initial urban development module and offers some preliminary observations from the work to date.

Forensic Risk Assessment in Intellectual Disabilities: The Evidence Base and Current Practice in One English Region

The growing interest in forensic risk assessment in intellectual disability services reflects the perception that deinstitutionalization has exposed more people to a greater risk of offending. However, ‘risk’ and the related idea of ‘dangerousness’ are problematic concepts because of connotations of dichotomous definition, stability and predictability. Assessment instruments in mainstream forensic psychiatry often combine actuarial and clinical data, and increasingly stress the dynamic nature of risk as well as the importance of situational and accidental triggers. Despite this increasing sophistication of research in mainstream forensic psychiatry, the ability to predict future offending behaviour remains very limited. Furthermore, actuarial predictors developed in studies of psychiatric or prison populations may not be valid for individuals with intellectual disabilities. Offending behaviour among people with intellectual disabilities is also hard to circumscribe because it often does not invoke full legal process or even reporting to the police. In order to discover how such problems were reflected in practice, a survey of providers in the North-west Region of England was undertaken. Seventy out of 106 providers identified as possibly relevant to this inquiry responded to a short postal questionnaire. Twenty-nine (42%) respondents – mainly in the statutory sector – reported operating a risk assessment policy relating to offending. The number of risk assessments completed in the previous year varied from none to ‘several hundred’. Providers reported three main kinds of problems: (1) resources or service configuration; (2) interagency or interdisciplinary cooperation or coordination; and (3) issues relating to the effectiveness, design and content of assessment.

The provision of primary care dental general anaesthesia and sedation in the north west region of England, 1996–1999

The provision of primary care dental general anaesthesia and sedation in the north west region of England, 1996–1999

The provision of primary care dental general anaesthesia and sedation in the north west region of England, 1996-1999.

To investigate trends in the provision of primary care dental general anaesthesia (DGA) and sedation following the new guidance from the General Dental Council. Cross-sectional analysis of data about the provision of DGA in the General Dental Service and Community Dental Service from 1996/97 to 1998/99. The North West Health Region of England. The numbers of DGAs in the General Dental Service (GDS) and Community Dental Service (CDS) for the three financial years, 1996/97, 1997/98 and 1998/99 were examined. In addition General Dental Service quarterly information about the numbers of general anaesthetics, sedations requiring another dentist or doctor, and claims for conscious sedation or inhalation sedation from April 1997 to December 1999 was requested from the Dental Practice Board. The numbers of DGAs declined by 24 per cent between 1996/97 and 1998/99. Those in the GDS fell from 14,550 in the first quarter of 1997/98 to 3,527 in the first quarter of 1999/2000. The number of claims for sedation, which required another dentist or doctor, increased from 712 in the first quarter of 1997/98 to 2,989 in the same quarter of 1999/2000, while the number of claims for conscious sedation and inhalation sedation increased slightly from 2,847 to 2,963 over the same period. The revised General Dental Council guidance has reduced the numbers of DGAs being carried out in both GDS and CDS. The number of sedations involving another dentist or doctor has increased considerably but the new guidance seems to have had little effect on the numbers of patients receiving operated administered conscious sedation and inhalation sedation.

Performance characteristics of the polymerase chain reaction to confirm clinical meningococcal disease

Objectives: To identify sources and routes of infection for sporadic cases of campylobacter infection in the North West of England.Methods: Standard, structured questionnaires were used to gather epidemiological information from cases of campylobacter infection in the North West Region of England between 1997 and 1999. The strains of campylobacter isolated from these cases were identified and typed using serotyping and phage typing methods. Analysis of combined serotype and epidemiological data is presented.Results and Conclusions: Human campylobacter infection in the North West is seasonal and a new observation was a peak in cases in March each year. Drinking bird-pecked milk was a highly seasonal exposure that might be an indicator of environmental contamination with campylobacter. A possible environmental basis for seasonality of infection is discussed. Frequencies of risk exposures related to serotypes of cases are described and a potential association was demonstrated between Campylobacter jejuni HS6 and consumption of bird-pecked milk. Also, Campylobacter coli infections were more commonly associated with travel abroad than C. jejuni and a decreased proportion of C. jejuni HS2 and C. jejuni HS11 reported consumption of meat and unpasteurised milk (respectively). Contact with a sick animal may be a significant risk exposure in younger age groups and in those who do not consume poultry or meat. It is clear from this and other studies that the sources and vehicles of human campylobacter infection are numerous and interventions that target a single risk factor are unlikely to impact significantly on the overall burden of disease.

Uncertainties in the compilation of spatially resolved emission inventories — evidence from a comparative study

This paper examines the nature and extent of uncertainties associated with spatially resolved emission estimates with particular reference to an examination of alternative emissions data. Evidence is taken from recent research into the development of generic methodologies for the estimation of emissions of key urban pollutants from anthropogenic sources in the North West region of England. The inventory results, which are available in terms of a regional 5×5 km grid, a sub-regional 1×1 km grid and at the scale of the original activity data, are useful for a number of air quality management tasks. However, the requirements of producing a generic methodology which uses readily available data sources has been found to limit the degree of detail with which it is possible to develop estimation procedures and this has implications for the level of confidence associated with the results and their further application. One of the principal limitations is the availability of equivalent activity data for a number of administrative units. A further assessment of the results of the North West inventory has been made through a comparative study of the inventory data with other emissions data covering a sub-set of the study area. These investigations indicate that there are a number of variations between inventory results in terms of overall emission magnitudes and their spatial distribution. Observed differences between the estimates are attributable to different sources of activity data and emission factors and also as a result of the geographical data used to represent sources.

Estimation of spatially resolved road transport emissions for air quality management applications in the North West region of England

Spatially resolved estimates of combustion and non-combustion related emissions of CO, NO x, VOCs and PM from road transport sources have been made for the North West region of England in 1994. These have been generated using detailed emissions models for combustion related emissions of CO, NO x, VOCs and PM which take into account the different emissions profiles associated with particular vehicle groups, different road types and journeys under cold start conditions. Emissions estimates have been generated for a 1×1 km grid covering the region’s urban and industrial zones and a 5×5 km grid for the whole study area. Emissions models have been generated and applied within a Geographical Information System (GIS) environment. Areas of uncertainty in the estimation procedure have been examined and the results compared with alternative data sources. Although the work centres upon the North West region of England, as far as possible the methods and data sources used are intended to be generic, particularly in respect to other administrative areas of the UK. In this way, this work can be considered to be of wider interest than at the local level alone.

An investigation into the ingestion of fluoride from toothpaste by young children

Objective To investigate the reported and observed brushing habits of young children and their ingestion of fluoride from toothpaste. Design In 1997, a random sample of 50 children, aged 30 months, from three districts in the North West region of England, were visited at home. Methods The reported and observed toothbrushing behaviour was determined and the weight of toothpaste applied to the toothbrush was measured. The amount of fluoride retained in the mouth after brushing with either a 400 ppm F or 1,450 ppm F toothpaste was determined. Results All parents claimed that their children's teeth were being brushed with a fluoride toothpaste at least once daily. The mean amount of toothpaste applied on the brush was 0.36 g of which 0.27 g (72%) was retained in the mouth. The mean amount of fluoride ingested per brushing was 0.42 mg when using the 1,450 ppm F toothpaste and 0.10 mg when using the 400 ppm F toothpaste. Although most parents applied a small amount of toothpaste a small minority applied a large amount. If using the 400 ppm F toothpaste twice daily no children of average weight would have exceeded ingestion of 0.05 mgF/kg body weight whereas 14 average weight children would have exceeded this value if using the 1450 ppm F toothpaste. Conclusions It is essential that parents of children aged less than 7 years apply a small (pea-sized) amount of fluoride toothpaste on the toothbrush and discourage swallowing.

Fluoride ingestion from toothpaste by young children.

To investigate the reported and observed brushing habits of young children and their ingestion of fluoride from toothpaste. In 1997, a random sample of 50 children, aged 30 months, from three districts in the North West region of England, were visited at home. The reported and observed toothbrushing behaviour was determined and the weight of toothpaste applied to the toothbrush was measured. The amount of fluoride retained in the mouth after brushing with either a 400 ppm F or 1,450 ppm F toothpaste was determined. All parents claimed that their children's teeth were being brushed with a fluoride toothpaste at least once daily. The mean amount of toothpaste applied on the brush was 0.36 g of which 0.27 g (72%) was retained in the mouth. The mean amount of fluoride ingested per brushing was 0.42 mg when using the 1,450 ppm F toothpaste and 0.10 mg when using the 400 ppm F toothpaste. Although most parents applied a small amount of toothpaste a small minority applied a large amount. If using the 400 ppm F toothpaste twice daily no children of average weight would have exceeded ingestion of 0.05 mgF/kg body weight whereas 14 average weight children would have exceeded this value if using the 1450 ppm F toothpaste. It is essential that parents of children aged less than 7 years apply a small (pea-sized) amount of fluoride toothpaste on the toothbrush and discourage swallowing.

Genital tract infections and the specialist gynaecologist: a survey of perception, diagnosis and treatment

The study was designed to investigate the attitude of gynaecologists to the management of genital tract infections in the North West Region of England. A postal questionnaire was sent to all members and fellows of The Royal College of Obstetricians and Gynaecologists with addresses in the region. A response rate of 71% was achieved. Of these 67% were male and more than 97% had been in the speciality for more than 5 years. Only 90.5% routinely obtain swabs from the posterior fornix; none from the pharynx. Forty-two per cent thought there might be a role for the genitourinary physician in the management of genital tract infections. Nineteen per cent engaged in consort tracing and only 22.6% carried out tests of cure before discharging the patients. Fifty-one per cent thought there could be grounds for litigation for not carrying out contact tracing and 27.4% agreed that not doing tests of cure may be regarded as negligence. This study revealed that there is a need for adequate training of gynaecologists with regards to the facilities available within the National Health Service.